J Liver Cancer.  2024 Sep;24(2):243-252. 10.17998/jlc.2024.05.26.

Role of transarterial chemoembolization for hepatocellular carcinoma with extrahepatic metastases in the era of advancing systemic therapy

• Song BG
• Goh MJ
• Kang W
• Sinn DH
• Gwak GY
• Paik YH
• Lee JH
• Choi MS

• KMID: 2559471
• DOI: http://doi.org/10.17998/jlc.2024.05.26

Abstract

Backgrounds/Aims
Systemic therapy is the current standard treatment for hepatocellular carcinoma (HCC) with extrahepatic metastasis (EHM). However, some patients with HCC and EHM undergo transarterial chemoembolization (TACE) to manage intrahepatic tumors. Herein, we aimed to explore the appropriateness of TACE in patients with HCC and EHM in an era of advanced systemic therapy.
Methods
This study analyzed 248 consecutive patients with HCC and EHM (median age, 58.5 years; male, 83.5%; Child-Pugh A, 88.7%) who received TACE or systemic therapy (83 sorafenib, 49 lenvatinib, 28 immunotherapy-based) between January 2018 and January 2021.
Results
Among the patients, 196 deaths were recorded during a median follow-up of 8.9 months. Patients who received systemic therapy had a higher albumin-bilirubin grade, elevated tumor markers, an increased number of intrahepatic tumors, larger-sized tumors, and more frequent portal vein invasion than those who underwent TACE. TACE was associated with longer median overall survival (OS) than sorafenib (15.1 vs. 4.7 months; 95% confidence interval [CI], 11.1-22.2 vs. 3.7-7.3; hazard ratio [HR], 1.97; P<0.001). After adjustment for potential confounders, TACE was associated with statistically similar survival outcomes to those of lenvatinib (median OS, 8.0 months; 95% CI, 6.5-11.0; HR, 1.21; P=0.411) and immunotherapies (median OS, 14.3 months; 95% CI, 9.5-27.0; HR, 1.01; P=0.973), demonstrating survival benefits equivalent to these treatments.
Conclusions
In patients with HCC and EHM, TACE can provide a survival benefit comparable to that of newer systemic therapies. Accordingly, TACE remains a valuable option in this era of new systemic therapies.

Keyword

Carcinoma, hepatocellular; Chemoembolization, therapeutic; Neoplasm metastasis; Antineoplastic agents

Figure

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  Figure 1. Overall survival according to initial treatment modality. Comparisons were performed using the log-rank test. Post-hoc pairwise comparisons of overall survival between treatment groups were performed using the log-rank test, with Bonferroni correction for multiple testing. TACE, transarterial chemoembolization; IO, immunotherapy.

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  Figure 2. Comparison of Kaplan-Meier curves in propensity score matched groups. (A) TACE versus TKI, (B) TACE versus IO, and (C) TACE versus non-sorafenib systemic therapies (lenvatinib and IO). Comparisons were performed using the log-rank test. TKI, tyrosine kinase inhibitor; TACE, transarterial chemoembolization; IO, immunotherapy.

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Reference

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